类风湿关节炎患者血清25(OH)D、血脂及炎症反应的关系

Correlations among serum 25(OH)D,serum lipids and inflammatory reaction in patients with rheumatoid arthritis

目的探究类风湿关节炎(RA)患者血清25羟维生素D[25(OH)D,VitD]、血脂及炎症反应的关系。方法 173例RA患者,根据血清25(OH)D水平分为VitD正常组(n=35)、VitD不足组(n=44)及VitD缺乏组(n=94),检测三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平、多普勒超声检查颈部血管评估患者双侧颈动脉粥样硬化程度。结果 VitD正常组TC水平显著低于VitD不足组和VitD缺乏组(P<0.01,P=0.014);HDL-C水平显著升高(P<0.01);VitD正常组DAS28评分、C反应蛋白(CRP)、红细胞沉降率(ESR)、斑块面积、斑块厚度、颈动脉内中膜厚度(IMT)水平显著低于VitD不足组和VitD缺乏组(P<0.01);ESR水平VitD不足组低于VitD缺乏组(P<0.05)。血清25(OH)D水平与TC、TG呈负相关(r=-0.221、-0.309,P<0.05),与HDL-C呈正相关(r=0.425,P<0.01),与斑块面积、斑块厚度、IMT呈负相关(r=-0.161、-0.405、-0.336,P<0.05)。斑块面积、斑块厚度、IMT与血清TC水平呈正相关(r=0.173、0.221、0.246,P<0.05),与HDL-C呈负相关(r=-0.476、-0.347、-0.296,P<0.05),与TG、LDL-C无明显相关性(P>0.05)。结论 VitD缺乏或不足可导致RA患者血脂代谢紊乱,增加RA患者罹患动脉粥样硬化的风险。

Objective To investigate the correlations among 25-hydroxyvitamin D [25（ OH） D],blood lipid and inflammatory reaction in patients with rheumatoid arthritis（ RA）. Methods RA patients（ n = 173） were divided into VitD normal group（ n = 35）,VitD deficient group（ n = 44） and VitD lacking group（ n = 94） according to 25（ OH）D level. Total cholesterol（ TC）,triglyceride（ TG）,high-density lipoprotein cholesterol（ HDL-C）,and low-density lipoprotein cholesterol（ LDL-C） were recorded. Doppler ultrasound examination of cervical blood vessels was performed to assess the degree of bilateral carotid atherosclerosis. Results The TC level in VitD normal group was significantly lower than those in VitD deficient group and lacking group（ P1 〈0. 01,P3= 0. 014）. The HDL-C level in VitD normal group was significantly higher than those in VitD deficient group and lacking group（ P1 〈0. 01,P3= 0. 023）. Serum level of 25（ OH） D was negatively correlated with TC and TG（ P〈0. 01）,and there were negative correlatins between plaque area,plaque thickness,IMT and serum 25（ OH） D levels（ P〈0. 05）. The DAS28 scores,CRP,and ESR levels in VitD normal group were significantly lower than those in VitD deficiency group and VitD lacking group（ P1,P2 〈0. 01）. The area of ultrasound carotid plaque,plate thickness,IMT were positively correlated with serum TC levels（ P〈0. 05）,and negatively with HDL-C（ P〈0. 05）. Conclusion Lacking or deficiency of VitD can lead to dyslipidemia and increase the risk of atherosclerosis in RA patients.